Rationale: The systematic application of health care directives to institutionalized populations in Ontario and Michigan may, in theory, improve satisfaction of both patients and families with health care and lead to more equitable and efficient health care resource allocation. This hypothesis requires testing. Aim: To determine the effects of the systematic application of the Let Me Decide directive in Ontario and the United States on the following outcome measures: patient and family satisfaction with involvement in the decision-making process related to care, satisfaction with the level of care received, health care utilization and health care costs. Study Design: A randomized control trial comprised of six matched pairs of institutions, three in Ontario and three in the United States. One in each three matched pairs of long-term care institutions in Ontario and three matched pairs in Michigan will be randomized to have an advanced directive systematically applied and the other to conventional practice. Each pair of homes will be matched for size, resident characteristics, mortality and hospitalization rates Subjects: All residents of the twelve Institutions selected for the study in Ontario and Michigan. Intervention: A nurse/social worker(SW) will be responsible for leading the intervention. The staff of each institution and of the local hospitals in the experimental groups will receive an educational package concerning advanced directives. The SW will offer each resident of the institution and their families the opportunity to complete an advanced directive. Control homes will continue with their usual policy regarding advanced directive. Measures of Outcome: Patient and family satisfaction with level of health care and involvement in decision-making related to care will be measured by newly developed reliable and valid instruments designed specifically for this population. Data will be collected prior to implementation of the directive and every six months thereafter. Health care utilization and costs will also be measured and this data will be collected one year prior to and one year subsequent to implementation of the directive.